ABSTRACT
The medical indications for circumcision include pathological phimosis, usually related to balanitis xerotica obliterans (BXO) and prophylactic circumcision in boys at risk of recurrent urinary tract infections due to an abnormal urinary tract. Ballooning of prepuce during micturition is of no consequence and not an indication for circumcision. Meatal stenosis can arise following circumcision, particularly in boys with BXO and those who have a circumcision while still in diapers. An alternative to circumcision is preputioplasty and intradermal steroid injection. Many boys opt for preputioplasty and the procedure should be discussed with boys and their parents as part of preoperative decision-making process. The main complication with preputioplasty is the recurrence of phimosis which may require circumcision in the future. The risk can be reduced by asking that boys retract and replace their foreskin twice a day, starting 2 weeks after preputioplasty. Boys and their families should be carefully counseled about the choice between circumcision and preputioplasty prior to undertaking either procedure.
